Lancet Series on Undernutrition Off Target To Save the Lives of Millions of Malnourished Children

Valérie Batselaere/MSF
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London/New York, January 16, 2008 – A series on maternal and child undernutrition in the current issue of the medical journal The Lancet, correctly puts the spotlight on nutrition as “a desperately neglected aspect of maternal, newborn, and child health.” However, because of weaknesses in analysis and outmoded recommendations the series is undermining efforts to promote urgently needed change.

Doctors Without Borders/Médecins Sans Frontières (MSF) teams are confronted daily with the devastating impact of childhood malnutrition, having treated more than 150,000 children in 99 programs in 2006. The organization’s medical staff sees first-hand how malnutrition weakens children’s resistance and increases the risk of dying from pneumonia, diarrhea, malaria, measles, and AIDS. They have also documented the dramatic impact of nutrient-dense, ready-to-use food (RUF) in treating childhood malnutrition.

A few of the weaknesses in the Lancet series:

  • By not including, for example, deaths from nutritional oedema, the highly lethal form of severe acute malnutrition which predominates in large parts of central and southern Africa, The Lancet series dramatically underestimates the number of deaths attributable to severe acute malnutrition;
  • A failure to actively endorse the new WHO, UNICEF, and WFP supported approach of community/home-based management of severe acute malnutrition with RUF;
  • A focus on hospital-based care in an era when ministries of health, UN agencies, and NGOs are actively moving to a proven strategy of community/home-based care with RUF. Only complicated cases are now treated in hospital;
  • The authors justify withholding strong support for community-based care on a lack of “randomized trials.” However, they go on to stress the usefulness of hospital-based care based on the results of nine studies, none of which are randomized.

MSF has been treating acute malnutrition with ready-to-use food since 2000 in African and Asian countries, including Afghanistan, Angola, Burundi, Ethiopia, Niger and Sudan. Outpatient/home-based strategies have permitted MSF to treat far more children than would have been possible in the past, when hospital-based treatment was the standard of care. Results have been most closely monitored in MSF’s program in Maradi, Niger, where hundreds of thousands of patients have been treated since 2001. In 2007, over 22,000 severely malnourished children were treated with a cure rate of 84 percent and a mortality rate of less than three percent.

Large-scale outpatient treatment of severe acute malnutrition is being successfully implemented by ministries of health, with support from implementing partners, in Malawi, Ethiopia, and Niger. However, despite strong UN recommendations to implement RUF treatment strategies, only about three percent of children with severe acute malnutrition have access to therapeutic RUF today. 1

By failing to strongly endorse and promote community treatment with RUF, the The Lancet authors are undermining the support for this lifesaving intervention.

Perhaps the conservative approach is based on the fact that new, more effective strategies with ready-to-use food will be more expensive, and will require international funding to purchase products (often locally). But considering the exceptional results achieved to date with RUF by MSF and others, and the potential to save lives, donors should fund and support recipient countries to rapidly scale-up this intervention. Implementation of this strategy will mean the difference between life and death for at-risk children under three.

MSF Background materials available online:

  1. MSF estimate based on RUF needed to treat all cases of Severe Acute Malnutrition (258,000 tons for 20 million children at an average of 12.9 kilos per child) and total estimated consumption in 2007 of 8,500 tons. ?